Tattoos Aren’t Easy to Erase

Forty-five-year-old Michelle Bauer can’t recall the boy’s name she had tattooed on her left arm at age 14.

The Marysville, Ohio, resident guesses it might have been “Denny,” though she can’t be sure. “It was so long ago,” she said.

Whatever the name of her former flame, she later covered it with a rose, and, more recently, a heart surrounded by a flame and floral detailing.

But tattoos, unlike fads, fancies or old boyfriends, don’t disappear over time. The Food and Drug Administration estimates that 45 million Americans have at least one tattoo — and that 8 million of them regret it. Some, like Ms. Bauer, choose to cover them up with new tattoos. Others opt for costly laser treatments or surgical removal.

“Once you’ve had a tattoo placed, that’s the easy part,” said Suzan Obagi, an assistant professor of dermatology and director of the UPMC Cosmetic Surgery and Skin Health Center. “The removal is a whole other subject. It entails many, many visits to the doctor and a considerable amount of cost to the patient to have it removed.”

Roxana Barad, the medical director at Pittsburgh’s Aesthetic Laser Center & Medi Spa, has noticed an increase in patients seeking tattoo removal. She currently sees more than 100 patients who have come in to erase tattoos from 20 years ago — or the night before.

Most of Dr. Obagi’s tattoo-removal patients are female, between 25 and 45 years old. Many inquire about the procedure but few actually go through with it because of the cost and discomfort, she said.

The best candidates for laser tattoo removal have black images on fair skin. Darker skin is more likely to blister and scar under the laser, Dr. Obagi said, since the laser targets any pigment in the skin, artificial or natural.

The process costs at least $200 per treatment, and most patients need between eight and 15 treatments. Despite the weighty financial burden of the removal, success is not guaranteed.

“I think it’s a generational thing,” Dr. Obagi said of those who want their tattoos removed. “There were a lot of people at one point getting it done in high school and college. Those patients are now in their 40s and late 30s and realizing that probably wasn’t the best thing. They have family obligations, job responsibilities, and they want to present themselves a little bit differently.”

Pigments are forever

But even if laser treatment makes the tattoo disappear on the skin, the pigments may never leave the body, Dr. Barad said.

“With any of these laser treatments, although the pigment is broken down … some of it will forever live in the regional lymph nodes where the tattoo was placed,” she said.

During the tattooing process, artists insert the pigment roughly one millimeter into the stable cells of the underlying dermis skin layer, where the ink is protected and preserved throughout the wearer’s lifetime — even if the wearer no longer wants it protected and preserved.

The U.S. Food and Drug Administration does not regulate tattoo inks or the pigments used in them. On its Web site, however, the FDA notes that many of the pigments used in tattoo inks “are industrial grade colors that are suitable for printers’ ink or automobile paint.” The site indicates that concerns raised by the scientific community regarding the pigments have prompted the FDA to investigate their safe use.

“The concern is that there is no regulation of these pigments, and yet it continues to reside in you forever,” Dr. Barad said, adding that are no hard facts about how tattoo pigment affects long-term health. And even if the pigments were regulated, Dr. Barad said, it wouldn’t make a difference for people who get their tattoos abroad.

Then there’s surgery

For those not satisfied with the laser results, plastic surgery is an alternative. Pittsburgh plastic surgeon Ray Capone is an expert in the surgical removal of tattoos — a process performed by cosmetic or dermatological surgeons who cut out the skin and tattoo, and suture the wound closed. It leaves a scar, but completely eliminates the image.

“I’m sort of like the final resting place for a lot of patients who are frustrated with laser removal procedures,” said Dr. Capone, of the Shadyside Surgery Center.

Attorneys, professional football players and a teacher have come to him for tattoo excisions, which usually take about 30 minutes to complete.

“I had a lawyer who was tired of the Daffy Duck [on her leg],” Dr. Capone said. “These girls were in college, and on an impulse decided to have something done … they go on to law school and they walk into a courtroom and it’s on their lower leg. It’s just hard to mask it.”

Bridget Miller, a technician and owner of the East Side Laser Center, has completed her official certification training in use of a Palomar “tattoo removing machine,” known as a Q-Yag 5, at the National Laser Institute in Scottsdale, Ariz. A portable tool, the Q-Yag 5 emits a range of laser pulse frequencies, which, when converted into heat, are able to break down ink and color compositions in the tattoos targeted for removal. When the particles dissipate, they are absorbed into the lymphatic system and the image fades.

National Laser Institute owner Shelly Cook thinks the excision process is becoming less popular with the new technology of lasers.

The success of laser removal can also be affected by the physical condition and health of the patient, Ms. Cook said. The percentage of the tattoo that can be broken down and absorbed depends on the composition and color of the ink as well as the location of the design on the body.

Ms. Cook said her clients’ average age is 30, a time when “you have to start going and getting a job” and “it’s a whole different ball game.”

For Amy Murray, 28, the time has come for the “impulsive punk” dragon tattoo fashioned on her arm 10 years ago to go. She now feels that having a tattoo makes her a target for negative stereotypes.

Ms. Murray embarked on a series of painful and costly laser treatments to remove the dragon design, which originally cost her $80. The laser therapy has yet to remove the dye completely from her skin, has induced changes in skin texture and coloring, and has already cost $600.

Long-time tattoo artist Tim Azinger, owner of Pinnacle Tattoo in Dormont, only wants clients “100 percent committed to not having second thoughts.”

“The acceptability of tattooing in the social realm has increased greatly,” Mr. Azinger said. However, “when spring and summer arrive … sometimes you get the stares and looks.”